- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $691.83 / $1,862.09
| Professional | | $186.21 | $691.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,905.46
| Professional | | $389.05 | $588.84 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $478.63 / $1,380.38
| Professional | | $239.88 | $478.63 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,951.21 / $10,471.29
| Facility | | $2,630.27 | $2,951.21 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $2,398.83
| Professional | | $269.15 | $1,202.26 | $2,398.83 |